title: The prevalence, severity, and association with HbA1c and fibrinogen of cognitive impairment in chronic kidney disease.
abstract: Cognitive impairment is a frequent finding in patients with chronic kidney disease (CKD). We examined cognitive performance in a prospective study of 119 patients with CKD stages 3-5 (including dialysis) and 54 control patients of the same age without CKD but with similar vascular risk profiles. Analysis included a comprehensive test battery evaluating memory, information processing speed, executive function, language, and visuoconstructive function, in addition to depression and anxiety. Thirty percent of patients with CKD had cognitive deficits (one or more s.d. below control patient performance). Cognitive deficits (T-value related to published norm values) were mild but significantly decreased to 48.8 in patients with stage 3-5 CKD not requiring hemodialysis and 47.2 in patients with stage 5D disease requiring hemodialysis, compared with 51.5 in control patients. Linear regressions among patients with CKD (forced entry strategy) showed that age (β=-0.50 per s.d.), HbA1c (β=-0.18 per s.d.), and fibrinogen (β=-0.18 per s.d.) predicted cognitive performance. Interestingly, HbA1c discriminated cognition in all age groups, while fibrinogen differentiated cognition particularly in patients over 70 years of age. Thus, our cross-sectional study suggests the severity of cognitive impairment in CKD is mild. As such, longitudinal studies are required to further characterize the role of cognitive deficits in CKD.
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Seidel
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Gronewold
authors.affiliation: Department of Nephrology, University Hospital Essen, Essen, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Volsek
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Todica
authors.affiliation: Department of Nephrology, University Hospital Essen, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.affiliation: Department of Nephrology, University Hospital Essen, Essen, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Bruck
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Hermann
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012720:Severity of Illness Index
chemical_list: D005340:Fibrinogen; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human